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Common Questons
| 1. Who is Informed Choice? |
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In 1998 Informed Choice Insurance Agency, opened their doors in a small office located in Green Bay, WI. Informed Choice was committed to providing personal service and informing seniors about their health care choices in an environment in which they feel comfortable. This process lead Informed Choice down a path that has made it possible for us to educate and inform individuals of all ages regarding their health and life insurance needs.
Today, Informed Choice is an independent agency that sells different types of Individual Health insurance (under 65), Long Term Care (LTC), Life Insurance, Burial Trusts, Dental, Medicare plans (traditional Medicare supplements, Medicare Advantage, Part D).
Our diverse team comes from various industries with unique backgrounds. But it’s what we have in common – talent, insight and a passion with our clients that keeps them coming back for more. We are able to determine what our client’s wants and needs are, not what we think they should have. We specialize in creating unforgettable, knowledgeable and exceptionally effective experiences.
Our office is staffed with licensed insurance agents and customer service representatives. A professional who is knowledgeable and understands your needs will answer your questions and provide solutions. Utilizing the latest technology allows us to provide you with honest, old-fashioned service.
We understand how overwhelming making the right insurance choices can be. Your advisor will carefully walk you through all those options, just like a friend or family member would, and we don’t stop their either! Informed Choice is more than a place that helps you make important decisions…..we stay with you for all those changes in the road that may lie ahead.
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| 2. How Can Informed Choice Help You? |
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With over a 100 years of combined experience, Informed Choice has worked with one generation to the next. We specialize in creating unforgettable, knowledge and exceptionally effective experiences with all your health and life insurance needs.
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| 3. What companies do you represent? |
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As a full-service, independent insurance agency, we represent many of the finest companies in the health and life industry.
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| 4. Why purchase from Informed Choice? |
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Our diverse team comes from various industries with unique backgrounds. But it’s what we have in common – talent, insight and a passion with our clients that keeps them coming back for more. We are able to determine what our client’s wants and needs are, not what we think they should have.
We’re particular about the quality of our work, so it follows that we’re also very selective about our partnerships. We work with companies whose products or services help us meet our clients’ needs. With these partnerships, we have the ability to extend and enhance our service delivery capabilities.
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| 5. What is the basic difference between individual and group health insurance coverages? |
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An individual policy is purchased by you directly with the insurance company.
With a group health insurance policy, the group is the master insured and the insurance company contracts with the group. Insurance certificates, issued to a participating member, act as your policy. Often group health insurance costs less than would have been charged had the insurance company sold individual policies to each member separately. In addition, group health insurance often contains special coverages that are not available or are very expensive on an individual basis. The purchasing power of the group makes this economically feasible.
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| 6. What types of individual health insurance policies are available? |
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There are a variety of policies which insurance companies offer on an individual basis. Some of the more common types of policies include:
1. Major Medical - provides coverage for doctor visits, surgery and hospitalization or ongoing illnesses.
2. Hospital and Surgery - provides coverage solely related to hospital stays and surgical services, such as room and board, laboratory tests, X-rays, plus doctors’ charges
3. Hospital Confinement Indemnity - a policy designed to pay a set amount (an indemnity) for each day you are an "in-patient" at a hospital.
4. Health Maintenance Organizations (HMOs) - centralized service provider, commonly with a general practitioner (limited selection of participating doctors) coupled with coverage by specialists upon referral. Doctor visits, surgery, hospitalization and often reduced-rate prescription medicine are provided. May also cover preventive care, often not included in major medical policies.
5. Specified Disease (also called “Dread Disease”) - covers costs associated with a single disease, such as cancer, AIDS, heart attack, etc.
6. Short-Term - typically a major medical policy but with coverage lasting only for a specified length of time. Might be purchased to cover the time you are between jobs.
7. Accident Only - provides coverage for doctor visits, surgery and hospitalization resulting from an accident (no coverage for disease or illness).
8. Dental - provides coverage for costs associated with dentists and orthodontists.
9. Vision - provides coverage for sight correction
10. Home-Health Care - care provided to enable you to remain in your home while receiving services which can range from assisted living (help around the house) to around-the clock nursing with other health care providers on call.
11. Long -Term Care - coverage provided to individuals who otherwise would not be able to take care of themselves. A range of services from delivery of prepared meals, assistance with managing the residence, to stays in residential facilities. Often associated with long-term illness and the elderly.
12. Limited - Benefit - not very common, a bare-bones type of coverage intended to cover specific situations.
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| 7. What types of group health insurance coverages are available? |
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Group health insurance makes individual coverages available on a group basis. A primary advantage is the purchasing power of the group that achieves reduced acquisition costs for the insurance company. The insurance company is then able to reduce the rate it charges to provide insurance for each individual member of the group. The Group is in a better position to bargain with the insurance company for additional benefits for its members. There are a variety of types of group health insurance plans, the major distinctions being the mechanism used for purchasing the insurance. Common varieties of group health insurance plans include:
1. Fully Insured Employer Group - The employer contracts directly with the insurance company to provide certificates to covered employees. Typical arrangement is either for major medical or health maintenance organization (HMO) coverages.
2. Small Employer Group - Insurance companies group certain industries together and then gather small employers together to form a larger group. These groupings enable the insurance company to better predict the cost of providing the insurance. The small employers can then get coverages otherwise not available unless charged a much higher rate. All the small employers get the same policy without deviation.
3. Large Employer Group - same as a fully insured employer group with direct contract between the insurance company and the employer to provide individual certificates to covered employees.
4. Health Maintenance Organization (HMO) - a group program under which the organization provides a full range of medical services to participants. Participants are either assigned or select from a group of general practitioners, who then refer their patients to specialists when the need arises. Good generalized system of providing medical care which is marked by curtailment in selection by the individual participant of the health care provider who render services. Individual participants insured by an HMO are called “enrollees”.
5. Self-Funded ERISA - available to large groups. The group contracts with an insurance company or third-party administrator to handle the paperwork. The group pays for all costs associated with the operation of the insurance plan itself, along with the added cost for administration.
6. Association Group - similar to a fully insured employer group, the distinction being that instead of an employer, it is a different type of group, such as a credit card company offering insurance as a benefit to its cardholders or a church group offering insurance to its parishioners.
7. Group Managed Care - a long-term health insurance plan offered through the group or association.
8. Preferred Provider Organization – another kind of health care network (doctors, hospitals, and other health care providers) that contracts with health insurance companies.
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| 8. What is the difference between primary and secondary coverages? |
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Since many people have available medical insurance from more than one plan (such as two employed spouses covered under group health insurance plans), insurance companies do not want insureds to profit through their health insurance. To prevent double recovery, most health insurance plans have provisions which determine how primary versus secondary coverage will be determined.
Primary coverage is provided through the plan of which they are a member (such as the spouses both covered through their respective employment - the primary coverage is provided under the plan provided by the employer of each spouse) or the plan under which the member has been a participant for the longest time period.
Secondary coverage, usually as a result of being covered as a dependent under someone else's health insurance plan, provides reimbursement for medical expenses after exhaustion of coverage available through the primary plan.
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| 9. How can I get health coverage? |
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Individual insurance
Health insurance which is purchased by the individual. Some major health insurance companies offer a broad range of coverages and options to individuals, who pay directly out-of-pocket for the cost of the insurance.
Employer-sponsored group insurance
Millions of people obtain their insurance through their employment. Upon reaching the eligibility requirement (such as a full-time employee working more than 40 hours per week for a six month continuous basis), the employee becomes covered under the employer's group insurance policy and the employee is issued an insurance certificate or health insurance card.
Association-sponsored insurance
You may belong to a group or organization that offers health insurance as a benefit of membership. Check membership benefit statements, brochures, or ask organizations leaders to determine availability of health insurance through your group or organization.
Government-sponsored insurance
Some states offer health insurance benefits to their residents, often with certain income requirements for eligibility.
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| 10. What is long term care? |
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Long term care refers to assistance with the very basic, everyday activities that most of us can do for ourselves. We call them ADLs or Activities of Daily Living. As a result of illness, injury or advanced age, many people need assistance in order to eat or dress or bathe. The need for long term care may also result because a person has cognitive impairment. Some people need supervision or reminders to accomplish every day activities, such as using the toilet, eating, bathing, dressing, and so forth.
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| 11. Who pays for Long Term Care? |
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About half of all long term care expense is paid by state Medicaid programs. About one-third is paid out of pocket by individuals and their families. Medicare only provides for some skilled care in some limited situations. Neither Medicare supplemental insurance nor major medical coverage provided by most companies pays for long term care. This leaves approximately one sixth of the total cost to be covered by other government programs and private insurance.
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| 12. Who should consider purchasing long term care insurance? |
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Anyone who is age 45 or older should consider long term care insurance when planning his or her insurance needs. "Consider" does not necessarily mean "purchase". Depending upon a person's particular insurance budget, there may be other insurance needs that deserve priority. Certainly, the purchase of long term care insurance should never create a financial hardship.
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| 13. Why should someone 45 years old worry about long term care? |
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It is difficult to know in advance who among us is going to need long term care. Also, it is difficult to predict who will develop a medical condition between the ages 45 and 60 that would preclude the purchase of long term care insurance -- when the potential need for assistance with ADLs is just a few years away. Another consideration is the premium, which is generally lower at younger ages. Early purchase can make long term care coverage affordable later on, particularly after retirement.
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| 14. Should We Purchase Long Term Care Insurance? |
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Income and assets will decide whether to consider insurance for Long-Term Care as well as how much is appropriate. If you have two-thirds of the cash flow needed to pay for the costs for a worst case scenario nursing care situation, you would only need the other third to be provided by Long-Term Care insurance. If you could produce one third of the costs from income and interest on assets, the other two thirds could come from Long-Term Care insurance.
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| 15. Does Medicare cover long term care? |
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Medicare will only provide for some skilled care in very limited situations. It was not designed to cover activities of daily living. Rather, it was designed to cover acute care or skilled care such as that provided during a short hospital stay.
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| 16. Does Medicaid cover long term care? |
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Yes, but in very limited situations. Medicaid will generally apply only to those with very low incomes and very few assets. Even then, there is only limited choice of what and where benefits will be provided. For example, there might be limited choice of physician and facility, no control over the number of people sharing a room, or no ability for the family to pay for any extras.
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| 17. Does medical insurance cover long term care? |
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Although medical insurance has some aspects of long term care, they are not the same thing. For example, some medical plans may pay for the services of a nurse while you are recovering from an illness or an injury that requires medical attention. This medical benefit is very limited. Once you are better or reach the maximum benefit for nursing services, this benefit would cease to be available. Medical insurance is not designed to cover activities of daily living. Long term care is designed to cover activities of daily living.
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| 18. I can buy nursing home insurance. Is that the same as a long-term care insurance? |
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Nursing home insurance is generally thought of as the predecessor of long term care insurance. Today it is possible to purchase a long term care insurance policy that only provides benefits when the insured is confined in a nursing home. It’s important to consider, however, if that is where the policyholder would want to be if he or she were well enough to stay at home and receive care.
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| 19. Why is it important to know how much nursing facilities charge in your area and the type of care you will receive? |
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The daily cost of staying in a nursing facility varies widely from one city to another. Also, the physical setting, ratio of care givers to patients, and the credentials of the staff members may also vary from nursing home to nursing home, even within the same city.
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| 21. What are my Medicare Options? |
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Many insurance companies offer individual policies that supplement the benefits available under Medicare. These policies are referred to as Medicare Supplement or Select policies.
Medicare Advantage Plans are also offered in Northeastern Wisconsin by private companies that sign a contract with Medicare. Medicare pays a set amount of money to these private health plans for your health care. They manage the Medicare coverage for their members.
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| 22. What is Medigap? |
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Individual Medicare supplement policies are designed to supplement the benefits available under the original Medicare program. Medicare supplement policies pay the 20% of Medicare-approved charges that Medicare does not pay. These Medicare supplement policies do not restrict your ability to receive services from the doctor of your choice.
Individual Medicare supplement policies include a basic core of benefits. In addition to the basic benefits, Medicare supplement insurers offer specified optional benefits. Each of the options that an insurance company offers must be priced and sold separately from the basic policy.
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| 23. What is a Medicare Select Policy? |
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Medicare select policies supplement the benefits available under the Medicare program and are offered by insurance companies and health maintenance organizations (HMOs). Medicare select policies are similar to standard Medicare supplement insurance. However, Medicare select policies pay supplemental benefits only if covered services are obtained through plan providers selected by the insurance company or HMO. Each insurance company that offers a Medicare select policy contracts with its own network of plan providers to provide services.
If you buy a Medicare select policy, each time you receive covered services from a plan provider, Medicare pays its share of the approved charges and the insurance company pays the full supplemental benefits provided for in the policy. Medicare select insurers must pay supplemental benefits for emergency health care furnished by providers outside the plan provider network.
In general, Medicare select policies deny payment or pay less than the full benefit if you go outside the network for non-emergency services. However, Medicare still pays its share of approved charges if the services you receive outside the network are services covered by Medicare. All Medicare select policies include a basic core of benefits.
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| 24. What is a Medicare Advantage Plan? |
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Medicare Advantage is a special arrangement between the federal Centers for Medicare & Medicaid Services (CMS) and certain insurance companies. Under this arrangement the federal government pays the insurance company a set amount for each Medicare beneficiary. The insurance company agrees to provide all Medicare benefits. The insurance company may provide some additional benefits, but it may also require payment of an additional premium. Beneficiaries under Medicare Advantage plans continue to pay the Part B Medicare premium to CMS. Your Medicare Advantage plan can terminate at the end of the contract year if either the plan or CMS decides to terminate their agreement. Medicare Advantage plans are not regulated by the State of Wisconsin Office of the Commissioner of Insurance. Therefore, these plans are NOT required to cover Wisconsin mandated benefits, nor are the plans guaranteed renewable for life like the Medicare supplement plans.
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| 25. What is a Medicare Prescription Drug Cover or commonly known as Part D or PDP? |
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Medicare Prescription Drug Coverage is insurance (part D or PDP). Medicare will contract with private companies to offer this drug coverage. These companies will offer a variety of options, with different covered prescriptions, and different costs. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium.
You choose the drug plan and pay a monthly premium. When you join a plan, Medicare helps pay the bill. Extra help is available for people with limited income and resources. People who may qualify will receive an application in the mail this summer.
As with any insurance program, you have options. In Fall 2009, you will receive information on what your drug plan options are. Although these plans will meet Medicare’s stringent requirements, they may differ in terms of costs and coverage. If you already have good drug coverage through a retiree plan or Medicare Advantage Plan, Medicare can provide help with its cost.
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| 26. How do you apply for Part D? |
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Everyone with Medicare, regardless of income, health status, or prescription drugs used, can get prescription drug coverage.
You may sign up when you first become eligible for Medicare (three months before the month you turn age 65 until three months after you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments. If you don't sign up when you are first eligible, you may pay a penalty. If you didn't join when you were first eligible, your next opportunity to join will be from November 15, 2009 to December 31, 2009.
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| 27. What is Life Insurance? |
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Life insurance is a contract, often called a “policy”, between you and an insurance company to provide money to a person you designate, in the event that you die during the time the contract is in force. In essence, during your lifetime you pay money, known as the insurance “premium”, to the insurance company. It promises to pay money to the persons you name, the “beneficiaries”, at your death. Some types of life insurance also give the policy owner the right to “borrow” a portion of the “cash value” within a policy, or to receive an “accelerated death benefit” if you become terminally ill or require confinement in a long term care facility.
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| 28. Do I need life insurance? |
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If you can afford it, there are several reasons why you may need life insurance. The most important reason is to have enough money to provide for dependents such as young children, non-working spouses or elderly parents, should you die and be no longer able to provide for them.
Also, your survivors may need funds to pay for extra expenses that may arise due to your death, such as funeral expenses, or other expenses to pay off bills and debts.
If you have no dependents or have adequate financial resources, you may not have an actual need to purchase life insurance. However, some people who do not “need” life insurance still purchase it anyway. This can be a means to leave money to a beneficiary or beneficiaries while minimizing tax consequences.
Another category of people who might want life insurance are business owners or people with substantial estates. Since these people have needs that require more planning, they should usually consult with professionals or specialists in insurance-related law, accounting or estate planning because legal business agreements or trust documents may need to be dran-up.
If you are someone in this last category, you should contact the appropriate professionals if you need their advice.
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| 29. Why buy life insurance? |
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Some reasons to buy life insurance are:
1. Income Replacement
2. Funeral Expenses
3. Pay Off Debts
4. Pay Off Medical Bills
5. Mortgage life insurance
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